Predictors of Outcomes in Patients with Primary Retroperitoneal Dedifferentiated Liposarcoma Undergoing Surgery

• Published in: Journal of the American College of Surgeons Vol. 218; no. 2; pp. 206 - 217
• Main Authors: Keung, Emily Z., MD, Hornick, Jason L., MD, PhD, Bertagnolli, Monica M., MD, FACS, Baldini, Elizabeth H., MD, MPH, Raut, Chandrajit P., MD, MSc, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2014
• Subjects: Adult; Aged; Aged, 80 and over; Digestive System Surgical Procedures - methods; Disease Progression; Disease-Free Survival; Female; Follow-Up Studies; Humans; Incidence; Liposarcoma - diagnosis; Liposarcoma - mortality; Liposarcoma - therapy; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; Prognosis; Retroperitoneal Neoplasms - diagnosis; Retroperitoneal Neoplasms - mortality; Retroperitoneal Neoplasms - therapy; Retrospective Studies; Surgery; Survival Rate - trends; United States - epidemiology; United States; OS; progression-free survival; well-differentiated liposarcoma; local recurrence-free survival; WDLPS; HR; FNCLCC; distant recurrence-free survival; LRFS; DDLPS; dedifferentiated liposarcoma; retroperitoneal; hazard ratio; overall survival; DRFS; PFS; French Federation of Cancer Centers Sarcoma Group; RP
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2013.10.009

Background Although sarcoma histology is recognized as a prognostic factor, most studies of retroperitoneal sarcomas report results combining multiple histologies and are inadequately powered to identify prognostic factors specific to a particular histology. We reviewed our experience with retroperitoneal dedifferentiated liposarcoma (RP DDLPS) to identify factors predictive of outcomes. Study Design All patients with RP DDLPS treated at our institution between 1998 and 2008 were reviewed. Multivariable Cox regression analyses were performed to identify factors predictive of progression-free survival (PFS), local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and overall survival (OS). Results We identified 119 patients with primary DDLPS. Median tumor size was 20.5 cm; 21% were multifocal. French Federation of Cancer Centers Sarcoma Group tumor grades were intermediate in 53% of patients and high in 28% (unknown 19%). Resections were complete (R0/R1) in 80% of patients and incomplete (R2) in 11% (unknown 9%). Tumors were removed intact in 72% of patients and fragmented in 16% (unknown 12%). Median follow-up was 74.1 months. One hundred patients (84%) experienced recurrence or progression, with 92% occurring in the retroperitoneum. Median PFS, LRFS, DRFS, and OS were 21.1, 21.5, 45.8, and 59.0 months, respectively, and were significantly worse with R2 resection. On multivariate analysis, tumor integrity (intact vs fragmented) was predictive of PFS, multifocality predicted LRFS, and extent of resection (R0/R1 vs R2), grade, and tumor integrity predicted OS. Conclusions In this cohort of primary RP DDLPS, factors under surgeon control (tumor integrity, extent of resection) and reflective of tumor biology (grade, multifocality) impact patient outcomes.